Abstract

PURPOSE: The optimal frequency of shock wave lithotripsy in urolithiasis treatment has not been well decided.

MATERIALS AND METHODS: A search of Medline, Web of Science and the Cochrane Library was performed and all randomized controlled trials including articles and meeting abstracts that compared the effects of different frequencies (120, 90 and 60 shock waves per minute [SWs/min]) of ESWL were included. The review process followed the guidelines of the Cochrane Collaboration.

RESULTS: Nine RCTs including 1572 cases were identified. Overall success rates and success rates for large stones (>10mm) were significantly lower in the 120 versus 60 (p<0.001 and p = 0.002, respectively) and in the 120 vs 90 (p <0.001 and p = 0.02, respectively) shock waves per minute groups, but similar between the 90 and 60 shock waves per minute groups. Treatment duration was significantly shorter in the 120 vs 60, 120 vs 90 and 90 vs 60 shock waves per minute groups (all p <0.001). Success rates for small stones (less than 10 mm), complication rates and total shock waves had no significant differences among the 3 groups.

CONCLUSIONS: Slowing frequency from 120 to 60 SWs/minute increased the overall success rates. While the duration of 60 SWs/minute was prominently greater, 90 SWs/minute seemed to be an optimal frequency, especially for large stones. 120 SWs/minute might still be recommended for small stones.

Kommentare
1

Meta analyses are tools to confirm or contradict the facts preserved in a good memory. They also frequently show that a lot of duplicating research and studies has been done to find out what has been stated years ago. This is nicely documented with the references 23 (Vallancien G, Munoz R, Borghi M et al: Relationship between the frequency of piezoelectric shock waves and the quality of renal stone fragmentation. In vitro study and clinical implications. Eur Urol 1989; 16: 41) and 28 (Delius M, Jordan M, Eizenhoefer H et al: Biological effects of shock waves: kidney haemorrhage by shock waves in dogs‐‐administration rate dependence. Ultrasound Med Biol 1988; 14: 689). Do people not read or do they forget?

Meta analyses are tools to confirm or contradict the facts preserved in a good memory. They also frequently show that a lot of duplicating research and studies has been done to find out what has been stated years ago. This is nicely documented with the references 23 (Vallancien G, Munoz R, Borghi M et al: Relationship between the frequency of piezoelectric shock waves and the quality of renal stone fragmentation. In vitro study and clinical implications. Eur Urol 1989; 16: 41) and 28 (Delius M, Jordan M, Eizenhoefer H et al: Biological effects of shock waves: kidney haemorrhage by shock waves in dogs‐‐administration rate dependence. Ultrasound Med Biol 1988; 14: 689). Do people not read or do they forget?
Peter Alken